Citation Information :
Barmon D, Kamei H, Kataki AC, Singh MP. Anterolateral Thigh Flap for Defect in Groin Area Following Resection of a Residual Disease of Vulvar Cancer: A Case Report. J South Asian Feder Obs Gynae 2018; 10 (4):288-290.
Introduction: Surgery for vulvar malignancies involves large defect, complicating wound healing and postoperative morbidity. However, it remains the mainstay of vulvar malignancy treatment. The prognosis for vulvar cancer is generally good with appropriate management. A multidisciplinary approach is desirable.
Case report: A 69 years female presented with complaints of swelling in genital region and occasional bleeding from the mass for 9 months. With World Health Organization (WHO) performance score of 3, stage IIIC squamous cell was diagnosed. Palliative radiotherapy was given, 6 weeks later the primary lesion disappeared but the inguinofemoral mass size remained. With the improved general condition, excision was done (left-sided inguinofemoral lymphadenectomy) with flap grafting (Anterolateral thigh flap). Postoperative recovery was good. An additional 30GyEBRT was well tolerated.
Conclusion: Advanced vulvar cancer surgery carries significant morbidity. With low incidence, the level of evidence for treatment of vulval cancer is low too. Reconstructive surgeries have shown reduction in morbidity and improvement in quality of life; but few studies are available evaluating the impact of such surgeries. ALT flap is a versatile perforator flap and hence, is useful in large vulvoperineal defect and large groin defect.
Taussig F. Cancer of the Vulva: An analysis of 155 cases: Am J Obstet Gynecol. 1940;40:764-770.
Way S. Carcinoma of the vulva. Am J Obstet Gynecol. 1960; 79:692-697.
Rodriguez M, Sevin BU, Averette HE, Angioli R, Janicek M, Method M. Conservative trends in the surgical management of vulvar cancer: a University of Miami patient care evaluation study. International Journal of Gynecological Cancer. 1997 Mar;7(2):151-157.
Magrina JF, Gonzalez-Bosquet J, Weaver AL, Gaffey TA, Webb MJ, Podratz KC. Primary squamous cell cancer of the vulva: radical versus modified radical vulvar surgery. Gynecologic Oncology. 1998 Oct 1;71(1):116-121.
Gentileschi S, Servillo M, Garganese G, Simona F, Scambia G, Salgarello M. Versatility of pedicled anterolateral thigh flap in gynecologic reconstruction after vulvar cancer extirpative surgery. Microsurgery. 2017 Sep;37(6):516-524.
Filobbos G, Chapman T, Khan U. Split anterolateral thigh (ALT) free flap for vulva reconstruction: a case report. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2012 Apr 1;65(4):525-526.
Benedetti Panici P, Di Donato V, Bracchi C, Marchetti C, Tomao F, Palaia I, et al. Modified gluteal fold advancement V-Y flap for vulvar reconstruction after surgery for vulvar malignancies. Gynecol Oncol. 2014;132(1):125-129.
Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap based on the septocutaneous artery. Br J Plast Surg. 1984;37:149-159.
Piura B, Masotina A, Murdoch J, Lopes A, Morgan P, Monaghan J. Recurrent squamous cell carcinoma of the vulva: a study of 73 cases. Gynecol Oncol. 1993;48(2):189-195.
Benedet JL, Turko M, Fairey RN, Boyes DA. Squamous carcinoma of the vulva: results of treatment,1938 to 1976. Am J Obstet Gynecol. 1979;134(2):201-207.
Creasman WT, Phillips JL, Menck HR. The national cancer database report on early stage invasive vulvar carcinoma. The American college of surgeons commission on cancer and the American cancer society. Cancer. 1997;80(3):505-513.